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The use of nitrofurantoin is contraindicated in patients with an estimated GFR of less than 30 mL/min/1.73m 2 as drug accumulation can lead to increased side effects and impaired recovery of the urinary tract, increasing the risk of treatment failure. [29] The use of TMP/SMX also raises concerns in patients with kidney disease.
[3] [8] The drug is available both by prescription and at lower doses over the counter. [2] [16] [4] [17] Besides for UTI prevention, methenamine is also available in a topical form to treat hyperhidrosis. [5] [6] [18] Side effects of methenamine are generally minor and include upset stomach, nausea, and headache, among others.
Symptoms of a kidney infection, on the other hand, are more systemic and include fever or flank pain usually in addition to the symptoms of a lower UTI. [10] Rarely, the urine may appear bloody. [7] Symptoms may be vague or non-specific at the extremities of age (i.e. in patients who are very young or old). [1] [11]
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It is one of the few drugs commonly used in pregnancy to treat UTIs. [38] There is a potential risk of hemolytic anemia in the newborn when used near time of delivery. [3] Newborns of women given this drug late in pregnancy had a higher risk of developing neonatal jaundice. [39] Evidence of safety in early pregnancy is mixed as of 2017. [40]
Its use during pregnancy is contraindicated, although it has been placed in Australian pregnancy category C. [13] Its use during the first trimester (during organogenesis) and 12 weeks prior to pregnancy has been associated with an increased risk of congenital malformations, especially malformations associated with maternal folic acid ...
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